Welcome to Professional and Technical Services (PTS) – experts in chemical disinfection for infection prevention. Our goal is to educate and provide you the latest resources related to cleaning and disinfection of environmental surfaces, medical devices and hands. As specialists in disinfectant chemistries, microbiology, environmental cleaning and disinfection, facility assessments and policy and procedure creation we are dedicated to helping any person or facility who uses chemical disinfectants.

Wednesday, October 24, 2012

The hospital’s Housekeeping Department is responsible for
the regular and routine cleaning of all surfaces and maintaining a high level
of hygiene in the facility in collaboration with the Infection Control
Committee. The Housekeeping Department’s charge is:

1. Classifying the different hospital areas by varying
need for cleaning;

2. Developing policies for appropriate cleaning
techniques-procedures, frequency, agents used, etc. for each type of room, from
highly contaminated to the most clean and ensuring that these practices are
followed;

3. Providing appropriate training for all departmental
staff both initially and periodically to assess competencies are maintained or
when a new technique, product or piece of equipment are introduced;

4. Establishing methods for the cleaning and disinfection
of the patient’s bed, mattress and pillow;

5. Determining the frequency for the washing/disinfection
of privacy curtains, walls, floors and furniture.

There should be a continuing program for staff training.
This program should stress personal hygiene, the importance of frequent and careful washing of hands, and cleaning methods (e.g., sequence of rooms,
correct use of equipment, dilution of cleaning chemicals and disinfectants,
etc.) Staff should also understand some basic microbiology
including the transmission of disease. Staff should also understand the causes
of surface contamination and how to limit the cross-transmission of organisms.

On September 18, 2012, the National Public Radio (NPR)
aired a segment titled, “Hospitals Fight to Stop Superbugs’ Spread”. Neal
Conan, host, interviewed three guests: Maryn McKenna, author, Superbug: The
Fatal Menace of MRSA; Dr. Eli Perencevich, professor, University of Iowa Carver
College of Medicine; and Dr. Deverick Anderson, co-director, Duke Infection
Control Outreach Network.

The topic centered on the so-called “NIH Superbug”, a
Klebsiella pneumoniae that resists most antibiotics, recently killed a seventh
patient at the National Institutes of Health Clinical Center in Maryland.
Similar outbreaks of health care-associated infections spread in hospitals
across the country every day.

McKenna said, “KPC and other bugs like it, which are
generally known as the highly resistant gram-negatives, they don’t just live on
skin. They live on surfaces that other bugs have difficulty surviving on,
things that aren’t organic and that have very low nutrients and very low
oxygen, like metal, like plastic, like the rails of a bed or the counter that a
computer rests on...And we haven’t thought so much about the environment around
the patient. It turns out that that’s what janitors know really well, or, to be
more polite, building services people or environmental services people. When
they go in the room, they’re not actually focusing on the patient; they’re
focusing on all the stuff around the patient: the bedrails, the counters, and
the call buttons.”

All three guests agreed with scientific studies
demonstrating the role that cleaning plays in saving lives. One well-trained,
conscientious hygiene specialist (i.e., Housekeeper, Matron, etc.) given the
proper tools, time and cleaning chemistry can prevent more infections than a
room full of doctors can cure. Environmental surfaces that are clean and
disinfected make it a safe environment in which patients can recuperate and go
home-without something they didn’t come in with. Cleaning certainly does play a
role in preventing infections and saving lives.

J. Darrel Hicks, BA, REH, CHESP

Author of “Infection Prevention for Dummies”

Go to: www.darrelhicks.com to order your FREE copy of
“Infection Prevention for Dummies” (just pay S&H) or to see other blogs and
articles.

Darrel Hicks is the author of Wiley Publishing's
"Infection Control For Dummies", and is nationally recognized as one
of the top experts in infection control. Darrel is also the immediate Past
President of the IEHA and is an active member in ASHES where he holds the
designation of CHESP. Darrel started his career in the management of
housekeeping services in 1981. He has worked in hospitals ranging in size from
20-500 beds, and knows what it takes to plan, set goals and provide guidance
and consultation to the management team and department(s) staff. He has managed
as many as 13 departments and 170 F.T.E.’s at one time in a 3-hospital system.
In that healthcare system Darrel had to pioneer and discover ways to save money
by cross training staff, job sharing, controlling overtime and putting a system
of controls in place.

Thursday, October 18, 2012

The third week in October is designated as International
Infection Prevention Week (IIPW) around the world. Infection Prevention and Control programs
have been widely recognized as a corner stone to preventing and controlling the
spread of infections both within the community and within healthcare
facilities. IIPW seeks to galvanize an
infection prevention movement at the grassroots level because infection
prevention is everyone’s business!Imagine a healthcare setting, a doctor’s office, a school or daycare
where everyone performs appropriate hand hygiene before and after providing
patient care or after using the loo! Imagine a community where every individual uses proper respiratory
etiquette by coughing and sneezing into their elbow or staying home when sick
so as not to infect coworkers. The
impact on a global level would be staggering!

While IIPW is often focused towards healthcare settings,
there is nothing to stop those of us who work in non-healthcare areas to
celebrate IIPW. There are numerous fun
and educational games or activities that can be tailored to any facility.A handwashing competition using Glo-Germ (UV
reflective goo), regardless of where you work is always entertaining!We did this a few years ago and the lengths
people took to be the best hand washer was pretty amusing.With the increased usage of ATP meters,
activities such as “who has the dirtiest cell phone or keyboard” can also open
one’s eyes as to the need for cleaning and disinfection of the surfaces we
touch and use frequently throughout the day.

So – are you ready to take the Infection Prevention
Challenge? Test your Infection
Prevention knowledge with the following questions.

1. Environmental cleaning can play an important role in
containing respiratory outbreaks because these viruses may remain infectious on
surfaces for _________ hours?

2. What viral pathogen, often isolated from enteric
outbreak specimens, has caused significant human disease in various settings such
as cruise ships, hospitals and schools? (Also, known as “winter vomiting
disease”)

3. Hands should be washed with soap and water when they
feel or look dirty, as well as:

Thursday, October 11, 2012

“I don’t like germs.That’s why I don’t like to shake hands.You just never know what that person did with his or her hand right
before it was offered to you to shake...... (Donald Trump)”

I couldn’t have said it better myself!Except, while Mr. Trump like Howie Mandel are
advocators of ceasing the “archaic tradition” of hand shaking to avoid germs,
my philosophy is “get a grip – go wash your hands.”

For centuries, hand hygiene has been considered an
important measure in promoting both public health and good personal hygiene.
There is a plethora of scientific evidence to support the fact that careful
attention to hand hygiene, lower rates of infectious disease in diverse
settings, such as health care facilities, child care centers, and
households.Fancy that, if you remove
germs from your hands you can disrupt person-to-person transmission of
infectious diseases!With the increased
recognition of the importance of hand hygiene in health care settings, the
assortment of hand hygiene products has expanded to include antimicrobial
foams, rubs, lotions, wipes, and soaps and with 7 Billion people worldwide, why
wouldn’t it?Hand hygiene products are a
very lucrative business to be in.

Similar to the surface disinfectant chemistries we have
been delving into over the past year, there are a slew of chemistries
traditionally used for hand hygiene.Like any chemistry, there are also concerns about the toxicity both
human and environment as well as resistance development.As hand hygiene is known to be probably the
single most important factor to stopping the spread of disease, development of
resistance to the potions, lotions, rubs and scrubs we use to clean our hand is
of vital importance.I would hazard to
say more so than even surface disinfectants as the “wash off” products that we
use to clean are hands enter the sanitary sewer system and ultimately into the
environment at far larger volumes than the surface disinfectants that we wipe
on a surface and allow to air dry.

According to the Centers for Disease Control and
Prevention (CDC), virtually all significant bacterial infections in the world
are becoming resistant to the antibiotic treatment of choice. “The CDC estimates that, each year, nearly 2
million people in the United States acquire an infection while in a hospital,
resulting in 90,000 deaths. More than 70 percent of the bacteria that cause
these infections are resistant to at least one of the antibiotics commonly used
to treat them.”Bacterial resistance
results in more visits to the doctor, a lengthier illness, the use of more
toxic drugs.It can also mean death.Similar to antibiotic resistance, the threat
of pathogens developing chemical resistance is very real.There is widespread concern over the
development of chemical resistance to the hand hygiene products currently used.

In 2013, we will be delving into each of the hand hygiene
actives so for the purposes of this blog I will not be going into “report card”
detail.For what I will refer to as the
“wash off” actives the primary chemistries used for hand hygiene include;
Quaternary Ammonium Chloride, Chlorhexidine, Parachlorometaxylenol or PCMX (a phenol derivative) and Triclosan.

If you recall from my “Rub-a-Dub-Dub, there’s a rubber duck in my tub” book review blog in July, Slow Death By Rubber Duck describes
in detail an experiment in which the author turned himself into a human guinea
pig.The level of Triclosan in his blood
shot up by 3,000%!!!Triclosan is
believed to interfere with thyroid function and is not metabolized by the human
body or even by the sewage waste process, making it an almost ubiquitous
environmental chemical in water.In
fact, in a study by U.S. Centers for Disease Control and Prevention scientists
detected Triclosan in the urine of nearly 75% of those tested (2,517 people
ages six years and older).The European
Union classifies Triclosan as irritating to the skin and eyes, and as very
toxic to aquatic organisms, noting that it may cause long-term adverse effects
in the aquatic environment.Environment
Canada likewise categorized Triclosan as potentially toxic to aquatic
organisms, bioaccumulative, and persistent.In other words, it doesn't easily degrade and can build up in the
environment after it has been rinsed down the sink or shower drain.

Suffice it to say, similar to the surface disinfectants
we have already investigated, due diligence into the type of hand soap we use
needs to be considered.As we are seeing
with surface disinfectants, oxidizing chemistries, especially hydrogen peroxide-based products are expanding because of their exceptional health and
safety and environmental sustainability profiles.H2O2 breaks down into water and oxygen meaning
is completely benign if rinsed down the drain and as it does not leave behind
any chemistry residue it will not lead to chemical resistance.While H2O2 is not an active that is widely
used for hand hygiene, a product based on hydrogen peroxide was recently
launched in Europe and will surely make its way to North America.

The next time you need to choose a hand hygiene product I
hope you’ll take time to consider the type of chemistry the hand soap you
choose uses and pick one that will be safer for you, me and the environment!

Friday, October 5, 2012

I admit it that there are times I can come across as
being too zealous, but when I truly believe an injustice is occurring, then I
need to do everything in my powers to ensure the issue is addressed.The widespread misuse of ATP(Adenosine Triphosphate) as a means for
comparing the effectiveness of different disinfectants is something that I
cannot leave unaddressed.To me it’s the
equivalent of trying to force a square peg into a round hole or for that matter
trying to use margarine to make shortbread....when butter is the only way to
go!

Don’t get me wrong, safe and effective disinfection of
high-touch environmental surfaces is an important tool in reducing the spread
of HAIs and the need for rapid and reliable means of monitoring the
effectiveness of such practices are also crucial for training and quality
control.I do agree that ATP has its
use; however, there are several limitations to the use of ATP within healthcare
facilities.First, the absence of
standardization of the ATP technology from various manufacturers and RLU
readings for use within healthcare makes cross-comparisons of readings and
benchmarking problematic.Second, the
lack of documented correlation between ATP readings and levels of microbial
contamination on environmental surfaces makes meaningful interpretation of the
data difficult and distinction between pathogenic and non-pathogenic microbes
on the sampled surface virtually impossible. Also, ATP kits cannot detect or
measure viral contamination because viruses possess no ATP.Third, and quite importantly, certain common
surface disinfectant chemistries and cleaning tools may interfere to varying
degrees with ATP measurements.Therefore, the use of ATP as a tool to determine the effectiveness of
different cleaning practices or to compare the effectiveness of different
cleaning and disinfectant chemistries remains a challenge.

While we have written a Technical Bulletin addressing
each of the limitations, it’s the limitation in the use of ATP as a comparator
tool that catches in my “caw” so to speak.From an infection control perspective, we want to ensure that we choose
the best disinfectant for our programs so the ability to create numbers to
compare different disinfectants is of great interest.Unfortunately, in our attempts to generate
numbers, we have overlooked the limitations of the ATP test itself.

The issue of different cleaning chemistries and their
potential to enhance or quench ATP bioluminescence is especially
significant.Quats and anionic
surfactants, for example, may give false positive results by enhancing RLU
readings by as much as 10%.One study
with Hydrogen Peroxide showed that concentrations of 0.1% did not have any
enhancing or quenching effects on the RLU levels; at 0.5%, quenching effects of
3 - 5% were observed. On the other hand, chlorine has been shown to have both
enhancing and quenching effects.At
concentrations of 100 ppm chlorine has been shown to significantly enhanced RLU
readings.As concentrations increased
to 500 ppm neither quenching or enhancing effects were observed, but as levels
of chlorine increase to those (e.g., 1,000-5,000 ppm),routinely used for environmental surface
disinfection in healthcare facilities there may be as much as a 40% deviation
in quenching, thereby potentially giving false negatives!Consequently, Boyce et al in their study on
the use of ATP for monitoring the effectiveness of hospital cleaning excluded
all those rooms which were disinfected with a 5,000 ppm bleach solution.

I’m not saying it’s wrong to use or that we should not
use ATP measurement kits to assess the degree of cleanliness of cleaned and disinfected
surfaces in healthcare settings.I am
simply asking that caution is used in the interpretation of the results because
several published studies have now documented the potential of cleaning tools
and disinfectant chemistries to either enhance or suppress the levels of RLU
and may in fact lead to either an over-estimation or an under-estimation of the
surface decontamination procedures in place.

Just as making a good shortbread requires butter, if you
want to really know how well a disinfectant is working (e.g. killing the bugs)
you need to conduct microbiological testing.